Outcomes for pediatric liver retransplantation from living donors

Background. The only therapeutic option for patients with a failing allograft is retransplantation. Living donor liver transplantation (LDLT) is a well-accepted therapeutic option for end-stage liver disease, but retransplantation from a living donor (Re-LDLT) has not previously been discussed. Methods. A total of 547 LDLTs were performed in 519 children (< 18 years old) at Kyoto University Hospital from June 1990 to October 2002. During the same study period, a total of 28 Re-LDLTs were performed in 27 recipients (Re-LDLT performed twice in 1 patient). Patient survival was analyzed with respect to various preoperative factors, such as functional status, pretransplantation apheresis, cause of primary graft failure, interval from primary to subsequent transplants, and laboratory values of total bilirubin and creatinine. Results. Kaplan-Meier survival rate from the date of Re-LDLT to 1 year was 47.6%. Functional status, pretransplantation apheresis, interval to Re-LDLT, and bilirubin and creatinine levels all exerted an adverse impact on survival after Re-LDLT. Pathologically proven major causes of primary graft failure were chronic rejection (n=10, 35.7%0), chronic cholangitis (n=6,21.4%), and vascular complications (n=7,25.0%). Among these causes, vascular complications displayed the strongest adverse impact on survival, compared with chronic cholangitis and chronic rejection (1-year survival was 35.7% in vascular complications; 66.7% in chronic cholangitis; and 60.0% in chronic rejection). Conclusions. Re-LDLT can save patients with a failing allograft. To achieve better results after Re-LDLT, further investigations are necessary to understand the factors leading to poor outcome after Re-LDLT.